Provider Demographics
NPI:1952300022
Name:OBRIEN, JOHN C JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:OBRIEN
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:3900 JUNIUS ST
Mailing Address - Street 2:SUITE 145
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1615
Mailing Address - Country:US
Mailing Address - Phone:972-386-7546
Mailing Address - Fax:972-661-3255
Practice Address - Street 1:3900 JUNIUS ST
Practice Address - Street 2:SUITE 145
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1615
Practice Address - Country:US
Practice Address - Phone:972-386-7546
Practice Address - Fax:972-661-3255
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2012-12-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXD68352086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113429802Medicaid
C19972Medicare UPIN
TX00314DMedicare PIN